Report a Claim

To submit a claim, please do one of the following:

  • After hours telephone: 780-463-7974
  • Send a claim via email.
  • Fill out the following form.
Required Fields are marked in Red
Date (mm/dd/yy):
Company Name:
Examiner:
Examiner Phone No.:
Claim No.:
Policy No.:
Coverages:
Insured:
Insured Address:
Insured Telephone No(s).:
Insured Driver:
Third Party (if applicable):
Third Party Telephone No(s).:
Third Party Address:
Date of Loss:
Location of Loss:
Loss Details:
Instructions:
© 2010 Townsend & Leedham Adjusters Ltd.